You’re pursuing a corporate strategy that hinges on aligning your hospitals and physicians, you now employ hundreds of physicians, you’ve spent untold sums of money to have a community EMR, and you’re consolidating your business office. Yet… you still operate your physician billing and hospital billing teams as independent and separate functions even though they’re addressing the same patient population during the same episode of care, sharing a common patient health record. As crazy as that seems, that’s the current paradigm for most every U.S. healthcare system.
With technology now enabling the level of physician/hospital collaboration to meet the rising tide of healthcare consumerism, patients and payers expect health systems to present clear, concise and correct patient billing statements. The public now expects more from providers in terms of price transparency than we demand of ourselves in terms of shared accountability for generating clean, complete and aligned patient bills. Insulating Physician Billing (PB) and Hospital Billing (HB) teams from one another is a high-stakes, double-blinded experiment costing your organization precious time and money while eroding your margins and consumer confidence. Now is the time to remove the Chinese wall separating your siloed billing functions by cross-pollinating your PB and HB information to optimize revenues across your enterprise.
Today, approximately 40% of U.S. physicians are employed by hospital systems. The rise in Accountable Care Organizations and new alternative payment methodologies placing provider organizations at-risk for the quality and financing of health care along with the economic challenges (ex. MACRA) of operating independent physician practices will push this figure over 50% with a projected 14% increase in physician employment between 2014 – 2024. With the investments made in recruiting, acquiring, managing and providing the technology tools for employed physicians along with the downward economic pressures on reimbursement, health systems must start innovating new ways of realizing the projected financial synergies their integrated delivery systems were designed to yield.
Revenue Assurance is a business activity utilizing data and process improvement methods to reduce revenue leakage thereby increasing profits, revenues and cash flows. Leakage comes in the form of missed, miscoded or misplaced charges that leach out of your revenue funnel. Missed charges, as the term implies, are the simple omissions when a charge didn’t make its way to the patient’s bill. Miscoded charges result from the normal variation of professional judgement involved in medical coding while Misplaced charges come from the fragmentation of our revenue cycle when we “park” charges in the various work queues within EMR systems awaiting further validation that potentially delays or prevents cash flow due to timely filing limitations if left unattended. In growing numbers, Miscoded charges also result from disharmony in the way PB and HB teams independently code for professional and technical services.
In the fall of 2016, AcuStream, Inc., the market leader in Healthcare Revenue Assurance developed the industry’s first set of predictive business rules to detect misaligned PB and HB charges giving healthcare providers a next generation innovative solution to this problem. Using similar algorithmic logic to that used by payers when reviewing/denying payment claims, AcuStream’s proprietary rules logic has produced the following results. On average, rules leveraging the HB/PB matching logic produced >30% of the total Revenue Assurance predictions ranging anywhere from 15% – 80% of the total predictions for individual clients performing Revenue Assurance activities across both their HB and PB organizations! Depending on the size of your organization, HB/PB matching logic can add millions to your net income and basis points to your profit margin.
For organizations looking to attack leakage and combat margin erosion, Revenue Assurance represents the low-hanging fruit of revenue optimization and a quick, certain way to shore up your revenue integrity function in a matter of weeks. It will also provide you the ability to share billing/coding information allowing your revenue teams to see each other’s work, share their insights, and improve billing accuracy. It’s time to remove the blinders and see the new possibilities for aligning financially across your hospital and physician organizations.
AcuStream is a Revenue Assurance specialty company dedicated to the healthcare industry. AcuStream provides automated charge capture auditing technology solutions, value-add professional coding expertise, and decision support tools to the country’s leading healthcare providers enabling our clients to find missed revenue around charges they didn’t know were missing. We are the only organization with proprietary algorithms and custom client specific rules, that can correlate both the hospital data and physician data. This in conjunction with our world class workflow, allows us to find and track missed, miscoded, and misplaced charges.
AcuStream identifies and quantifies missed reimbursable charges for both Physician Organizations and Health Systems. REVBUILDER™’s automated post-bill auditing solution identifies omitted charges while REVREVIEW™ auditors validate charges against your own EMR documentation and payer contracts to ensure you get paid for the services provided.
AcuStream has been privileged to work with one-third of the academic medical centers on the U.S. News and World Report “Honor Roll of Best Hospitals,” seven of the 50 largest integrated health systems, twenty percent of the 20 largest not-for-profit health systems, and 10 of the nation’s largest physician group practices providing immediate financial lift/profitability, management insights and process improvements surrounding Revenue Management.Acustream currently processes over 100,000 doctor’s data on a monthly basis, thanks to our client base of top hospitals and physician organizations in the US. The result of our solution is improved net profit, decreased revenue erosion, and a clear view into departmental efficiencies.
We help you identify the missing pieces to your revenue puzzle, BEFORE you even start to put the puzzle together.